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The Kalyani cohort created in 2010 by the National Institute of Biomedical Genomics, West Bengal, India, is designed to serve as a platform for conducting prospective basic and translational studies on epidemiology and genomics of health and disease-related parameters, particularly of non-communicable diseases (NCDs). The overall goal is to assess behavioural, biological, genetic, social and environmental factors and obtain necessary evidence for effective health improvement. Collected baseline data comprise 15727 individuals, >14 years of age from seven municipal wards in the Kalyani and Gayeshpur regions. Data are being collected on demographics, current health status, medical history and health-related behaviours. Blood samples were also collected from a subset of individuals (n = 5132) and analysed for estimation of known markers of NCDs. DNA has been extracted from blood samples and stored for future use. Important baseline findings include a high prevalence of diabetes, dyslipidemias and hypothyroidism. Prevalence estimates for these disorders obtained from self-reported data are significantly lower, indicating that participants are unaware of their health problems. The identification of ‘at risk’ individuals will allow formation of sub-cohorts for further investigations of epidemiological and genetic risk factors for NCDs. Access to the resource, including data and blood samples, created by this study will be provided to other researchers.

This study examines the associations between subjective memory complaints (SMC) and health variables: multimorbidity, presence of certain diseases, health perceived state, difficulties seeing and hearing, pain, and use of medications and health services. Furthermore, we aim to identify risk groups based on multimorbidity and calculate the effect size for each of these relationships.

Methods:

Cross-sectional epidemiological study using a face-to-face interview with a structured questionnaire. Sample size: 1,342 people aged 65 years and older taken from a random sample of the census tracts. SMC were studied using questions regarding memory complaints.

Results:

Multimorbidity and polypharmacy are associated with SMC, so are impaired vision and hearing. SMC are more frequently present in people who use health services more intensively and exhibit reduced functional activity as a result of diseases. With respect to specific diseases, only cerebrovascular accidents and chronic constipation were associated with SMC. In regression analysis, predictors of SMC were vision and hearing impairment, poor self-perceived health, pain, and general practitioner visits. However, the effect size of these factors is low. The variables that indicate risk groups are number of diseases, reduced functional activity, hearing impairment, and poor self-perceived health.

Conclusions:

Memory complaints are a heterogeneous phenomenon. Our results confirm that multimorbidity, polypharmacy, greater use of health services, pain, and poor self-perceived health are associated with SMC. We identified two risk groups with a high percentage of complaints and a healthy group with a low percentage. Detecting these factors and these risk and healthy groups is useful in achieving proper patients management.

Studies on whether the co-occurrence of psychotic experiences (PEs) and depression confers a more pronounced decrement in health status and function compared with depression alone are scarce in the general adult population.

Method

Data on 195 479 adults aged ⩾18 years from the World Health Survey were analysed. Using the World Mental Health Survey version of the Composite International Diagnostic Interview (CIDI), depression in the past 12 months was categorized into four groups: depressive episode, brief depressive episode, subsyndromal depression, and no depression. Past 12-month psychotic symptoms were assessed using four questions on positive symptoms from the CIDI. Health status across seven domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort, vision) and interviewer-rated presence of a mental health problem were assessed. Multivariable logistic and linear regression analyses were performed to assess the associations.

Results

When compared with those with no depression, individuals with depression had higher odds of reporting at least one PE, and this was seen across all levels of depression severity: subsyndromal depression [odds ratio (OR) 2.38, 95% confidence interval (CI) 2.02–2.81], brief depressive episode (OR 3.84, 95% CI 3.31–4.46) and depressive episode (OR 3.75, 95% CI 3.24–4.33). Having coexisting PEs and depression was associated with a higher risk for observable illness behavior and a significant decline in health status in the cognition, interpersonal activities and sleep/energy domains, compared with those with depression alone.

Conclusions

This coexistence of depression and PEs is associated with more severe social, cognitive and sleep disturbances, and more outwardly apparent illness behavior. Detecting this co-occurrence may be important for treatment planning.

To determine if there is gender or laterality predilection in patients with semicircular canal dehiscence syndrome.

Methods:

A multi-institutional chart review was performed to identify patients diagnosed with semicircular canal dehiscence between 2000 and 2015. A systematic literature search was conducted using PubMed to further identify patients with semicircular canal dehiscence. Age, gender and laterality data were collected. Statistical analysis was performed to evaluate for gender or laterality preponderance.

Results:

A total of 682 patients with semicircular canal dehiscence were identified by literature and chart review. Mean age of diagnosis was 49.75 years (standard deviation = 15.33). Semicircular canal dehiscence was associated with a statistically significant female predominance (chi-square = 7.185, p = 0.007); the female-to-male ratio was 1.2 to 1. Left-sided semicircular canal dehiscence was most common, followed by right-sided then bilateral (chi-square = 23.457, p < 0.001).

Conclusion:

Semicircular canal dehiscence syndrome is most commonly left-sided and exhibits a female predominance. This may be secondary to morphological cerebral hemisphere asymmetries in both sexes and a predilection of women to seek more medical care than men.

A significant proportion of Q fever patients from the first Dutch Q fever outbreak in 2007 showed impairment in health status up to 1 year after infection. Interested in whether this decrease in health status persisted, we set out to determine the health status in the same cohort of patients, 4 years after primary infection and to compare health status scores at the individual patient level between 1 and 4 years follow-up. Health status was assessed with the Nijmegen Clinical Screening Instrument (NCSI). Patients were serologically tested to exclude patients with possible, probable or proven chronic Q fever. Results on the NCSI sub-domains at group level [2008 (n = 54) and 2011 (n = 46)] showed a persistent significant percentage of patients exhibiting clinically relevant (‘severe’) scores for all NCSI sub-domains. After 4 years, undue fatigue was present in 46% and exactly half of all patients experienced a severely impaired general quality of life. Patients with NCSI scores available in both 2008 and 2011 (n = 37) showed no difference in all sub-domain scores, except for a small decrease in dyspnoea emotions in 2011. In this group, a significant proportion of patients either improved or worsened in one or more sub-domains of health status. We conclude that at the group level, health status of Q fever patients remained impaired 4 years after primary infection. At the individual patient level, health status may change.

The prevalence of dietary supplement use varies largely among populations, and previous studies have indicated that it is high in the Danish population compared with other European countries. The diversity in supplement use across countries indicates that cultural and environmental factors could influence the use of dietary supplements. Only few studies investigating the use of dietary supplements have been conducted in the Danish population. The present cross-sectional study is based on 54 948 Danes, aged 50–64 years, who completed self-administrated questionnaires on diet, dietary supplements and lifestyle between 1993 and 1997. A health index including smoking, physical activity, alcohol and diet, and a metabolic risk index including waist circumference, urinary glucose and measured hypertension were constructed. Logistic regression was used to investigate these determinants in relation to the intake of dietary supplements. We found that 71 % of the participants were dietary supplement users; female sex, older age groups and higher educated participants were more likely to be users of any dietary supplements. One additional point in the health index was associated with 19, 16 and 9 % higher likelihood of being user of any, more common and less common supplements, respectively. In the metabolic risk index, one additional point was associated with 17 and 16 % lower likelihood of being user of any supplement and more common supplements, respectively. No significant association was found for less common supplement use. In conclusion, those with the healthiest lifestyle were more likely to use dietary supplements. Thus, lifestyle and dietary composition should be considered as confounders on supplement use and health outcomes.

Exercise has a complex influence on the biochemical markers of inflammation that includes suppression of pro-inflammatory cytokines and promotion of anti-inflammatory cytokines. The magnitude of this effect is large for prolonged activity at high work rates. People who are able to perform regular mild–moderate exercise have lower baseline pro-inflammatory cytokine levels that appear to be associated with a number of health benefits, including reduced all-cause mortality. These effects extend into old age. Interleukin-6 (IL-6), a pleiotropic myokine released by active muscle cells, appears to play a central role in these observed phenomena, though the mechanisms of action are intricate and incompletely understood. The minimum threshold of the exercise–cytokine dose–response, if any, has not been clearly characterized. Therefore, the potential to influence cytokine activity and reduce age-associated inflammation in very aged or frail people able to perform only very low levels of physical activity is unknown.

This is the first study performed to determine the health status of the geoduck Panopea abbreviata in the San José and San Matías Gulfs (North Patagonia, Argentina). The study was based on 120 geoducks collected (30 specimens in each season) at Fracasso Beach (42°25′S 64°07′W) (San José Gulf) and 30 specimens collected during the austral summer at Puerto Lobos (42°00′S 65°05′W) (San Matías Gulf). The parasites found (prevalence in parentheses) were: prokaryotic inclusions (32.2%) were recorded in the epithelium of the digestive gland and gill filaments; ciliates (79%) mainly found in gills; Porospora-like gregarines (15.2%) in the connective tissue between inner and outer mantle epitheliums; the turbellarian Paravortex panopea (27.1%) in the intestine lumen; the nemertean Malacobdella arrokeana (98.3%) in the pallial cavity; and the green alga Coccomyxa parasitica (51%) parasitizing the haemocytes in the connective tissue of the distal end of the siphon. The highest mean parasitic abundance value was found in the late austral spring (November), coinciding with the lowest values of the condition index of the host. The populations of P. abbreviata from San José Gulf seemed to be devoid of severe pathogens.

Following the removal of antibiotic growth promoters in animal feed, various products have been suggested as alternatives to the poultry feed industry. Among these products some types of clay or derivatives were used as a natural supply in order to optimise performance. Clay is indeed abundant naturally, cheap, widely used by hens raised outdoors voluntarily or by ingesting earthworms and soil fauna insects. As an indication it was estimated that a laying hen kept outdoors consumes 10g of soil, 7g of plant and 20g of insects and worms per day. In further studies it was reported that soil ingestion can reach 30% of dry matter intake. Considering their specific absorption capacities of ions, clays are considered real molecular sieves. Various studies have concluded that clays promote a hygienic digestive tract, increase food retention time and contribute to improving water retention and reducing the moisture content of droppings. The use of clays was accompanied by positive responses in nutrient digestibility, weight gain and feed conversion ratio. Also the addition of clay enhances meat sensorial value and organoleptic characteristics, the cutting yield and meat processing abilities. The antimicrobial and antitoxic properties of clay were shown to improve the appetite and weight gain of chickens eating food containing aflatoxins. In laying hens literature states that the use of clay improves egg size, egg internal qualities, shell strength and wet droppings. Clay use is also reported to reduce mite infestation in hens and improve ambient conditions in animal husbandry with substantially lower levels of NH3 and CH4.

Q fever patients are often reported to experience a long-term impaired health status, including fatigue, which can persist for many years. During the large Q fever epidemic in The Netherlands, many patients with a laboratory-confirmed Coxiella burnetii infection were not notified as acute Q fever because they did not fulfil the clinical criteria of the acute Q fever case definition (fever, pneumonia and/or hepatitis). Our study assessed and compared the long-term health status of notified and non-notified Q fever patients at 4 years after onset of illness, using the Nijmegen Clinical Screening Instrument (NCSI). The study included 448 notified and 193 non-notified Q fever patients. The most severely affected subdomain in both patient groups was ‘Fatigue’ (50·5% of the notified and 54·6% of the non-notified patients had severe fatigue). Long-term health status did not differ significantly between the notified and non-notified patient groups, and patients scored worse on all subdomains compared to a healthy reference group. Our findings suggest that the magnitude of the 2007–2009 Q fever outbreak in The Netherlands was underestimated when only notified patients according to the European Union case definition are considered.

Background: Comorbidity in older adults may lead to lower perceived health status and a decrease in quality of life (QoL). The objective of this study is to analyze the relationship between comorbidity, health status, QoL, and dementia in institutionalized older adults.

Methods: Cross-sectional, multicenter study in residential care settings in Spain. Two groups of institutionalized older adults of 60 years of age and older were compared: 234 persons with normal cognitive function and 525 with dementia according to DSM-IV-TR criteria. Assessments included: sociodemographic questionnaire, EQ-5D index for health-related QoL, Visual Analogue Scale (EQ-VAS) for health status, number of chronic medical conditions (comorbidity), Barthel Index for functional independence, and Short Portable Mental Status Questionnaire.

Results: The group with dementia presented significantly worse QoL, health, and functional status than people without dementia. The most prevalent chronic medical conditions were musculoskeletal (72.3%), followed by genito-urinary disorders (60.2%). Controlling for age and sex, people with dementia and higher comorbidity exhibited lower EQ-VAS scores; however, no significant difference was found for the EQ-5D index. The health conditions that contributed the most to the EQ-VAS differences between the dementia and non-dementia groups were sight, oral, and genito-urinary problems.

Conclusions: When compared to older adults with no dementia, people with dementia and high comorbidity reported the most compromised health status, especially in those with sight, oral, and genito-urinary problems. These differences should be taken into consideration when selecting strategies to maintain and improve the health status of older adults in residential care settings.

The goal of this research was to study the effect of the substitution of wheat starch by potato starch (PS) on the performance, health and digestion of growing rabbits. Three experimental diets were formulated with 0%, 7% and 14% PS (PS0, PS7 and PS14, respectively) and similar starch contents (22% dry matter basis), proteins and fibre. The three diets were administered to three groups of 48 rabbits from weaning (28 days) to slaughter (70 days), and growth and health measurements were made. Another 10 rabbits per diet (30 rabbits at each age), reared under similar conditions, were slaughtered at 6 to 10 weeks of age, and the digesta were collected to analyse the caecal microbial activity (pH, volatile fatty acids (VFA) levels, fibrolytic activity) and the starch concentration in the ileal digesta. At the same ages, the whole tract digestibility coefficients were measured in 10 other rabbits for each treatment (30 rabbits). The feed intake between 28 and 42 days of age (days) increased by 11% (P < 0.05) in PS0 v. PS14. Over the whole growth period (28 to 70 days), weight gain was similar among diets (40.5 g/day), whereas the feed intake and feed conversion increased (8.5% and 5.2%, respectively; P < 0.05) with the PS14 diet. Mortality and morbidity were not affected by the diets. The starch concentration of the ileal contents increased (P < 0.01) with the addition of PS to the diet (0.39%, 0.77% and 1.08% for diets PS0, PS7 and PS14, respectively). Starch digestibility was 0.8 percentage units higher (99.8% v. 99.0%) with the PS0 diet than the PS14 diet (P = 0.04). The bacterial cellulolytic activity in the caecum tended to be higher with the PS14 diet (P = 0.07). The total VFA caecal concentration increased (P < 0.01) only in 6-week-old rabbits with PS7 compared with PS0 (54.7 v. 74.5 mmol/l). Protein digestibility and ileal starch concentration decreased (P < 0.05) with age (6 v. 10 weeks), and hemicelluloses digestibility increased (P < 0.05). At 10 weeks of age, rabbits showed a higher VFA pool (6.25 mol) and proportion of butyrate (15.9%) and a lower proportion of acetate (79.3%), ammonia level (7.5 mmol/l) and C3/C4 ratio (0.31) than at 6 weeks of age. The intake of potato starch had no effect on the performance, caecal microbial activity or digestive health of growing rabbits.

Background: Frailty can be defined as the presence of multiple, interacting medical and functional problems. Frailty is associated with psychiatric conditions but its relation to psychological well-being is unclear. A “frailty identity crisis” has been proposed as a maladaptive response to the sense of self as health deficits accumulate. We evaluated this so-called identity crisis by investigating associations between well-being, frailty, and mortality in community-dwelling older Canadians.

Methods: In this secondary analysis of the Canadian Study of Health and Aging (N = 5,703; age 70+), frailty was defined by an index of 33 health deficits. Psychological well-being was measured using Ryff's 18-item scale, with six domains (autonomy, personal growth, environmental mastery, positive relations, purpose in life, and self-acceptance). Cognition was measured using the Modified Mini-Mental State Examination. Associations between well-being, frailty, and mortality were measured using linear regression, adjusting for age, sex, education, cognition, and mental health.

Results: For each additional frailty-defining deficit, the psychological well-being score worsened by 0.3 points (0.29, 95% CI: 0.22–0.36, p < 0.001), independent of age, sex, education, cognition, and mental health. Among the six domains of well-being, only “purpose in life” and “autonomy” were not associated with frailty (all others, p < 0.001). Worse psychological well-being was associated with five-year mortality independent of age, sex, education, frailty, and mental health; this association was not statistically significant when adjusting for baseline cognition.

Conclusions: Frailty was associated with low levels of well-being. Psychological well-being impaired by a frailty identity crisis may play an important role in defining subjective health in older adults.

Canadian Cardiovascular Society consensus guidelines recommend that tetralogy of Fallot patients be seen by a congenital cardiologist every 2 years. In Atlantic Canada, tetralogy of Fallot patients are followed up at either tertiary or satellite clinics, which are held in the community and attended by paediatric cardiologists. The effectiveness of satellite clinics in congenital cardiac disease follow-up is unproven. Our objective was to compare patient-reported quality of life measures to determine whether these were impacted by the site of follow-up.

Methods

We included patients with tetralogy of Fallot undergoing surgical repair at the Izaak Walton Killam Health Centre from 1 November, 1972 to 31 May, 2002. Quality of life surveys, SF-10 or SF-36v2, were administered to consenting patients. We analysed the subjective health status by patient age and site of follow-up.

Results

Of the 184 eligible patients, 72 were lost to follow-up. Of the locatable patients, 61% completed the questionnaires. In all, 90% (101 out of 112) were followed up at recommended intervals. Of the 112 (68%) patients, 76 were followed up at a tertiary clinic. These patients were older, with a mean age of 18.4 years versus 14.7 years, and scored higher on the SF-36 physical component summary (52.6 versus 45.7, p = 0.02) compared with satellite clinic patients. The SF-36 mental component summary scores were similar for patients regardless of the site of follow-up. SF-10 physical and psychosocial scores were similar regardless of the site of follow-up.

Conclusion

Tetralogy of Fallot patients followed at either satellite or tertiary clinics have similar subjective health status.

Partnerships for Older People Projects (POPP) was a national initiative in England aimed at improving health, well-being and quality of life (QoL) for older people by developing local services. This development paper reports the key findings of a local evaluation in relation to quality of life, well-being and health-related QoL to provide practical understanding at the local level about what this means in relation to the schemes delivered.

Objectives

To identify the impact of POPP schemes received by older people in Wigan on their QoL and well-being; and establish their feedback on services using local indicators.

Methods

Convenience samples of older people receiving services from three selected ‘community facing low level’ schemes were recruited over a two-month period. They completed a semi-structured questionnaire at baseline (T1) and at follow-up 6 weeks later (T2). Information was collected on health status and health-related QoL using the EQ-5D, biographical information, overall QoL and well-being as part of the national evaluation and a local indicator, feedback on services.

Results

Response rates were 70% (T1 45/64, mean age 72 years) and 43% at T2 (25/58, mean age 55 years). Following receipt of these schemes improvements were found for self care, anxiety and depression, health status and QoL although these differences were not statistically significant due to the small sample size and loss to follow-up. Feedback on local service use related to schemes ‘being fit for purpose’ and ‘aspects of service delivery’.

Conclusion

This local evaluation illustrates a pragmatic approach to service development and delivery of preventative services, with potential to benefit health and well-being of older people and support their continued living independently in the community. It provides detail and better understanding of what this means locally to people in context of national findings.

The purpose of the study was to determine patterns of diet use among middle-aged Australian men and women and the relationships between these different usage patterns and demographic characteristics, health status and health habits. A cross-sectional mail survey was conducted among a random sample of 2975 people aged 40–71 years in Victoria, Australia. A total of 1031 usable questionnaires were obtained which included information about the use of diets (e.g. low-fat and low-salt) during the past 3 months along with demographic information, health status and health habits. Based on the responses about the use of thirteen diets for both sexes, latent class analysis was employed to identify the optimal number of use of diets and the assignment of participants to particular groups. Three types of diet uses were identified and provisionally named: diet use, selected diet use and non-diet use. This classification was associated with demographics, health status and health habits, and these associations differed between men and women. The findings suggest that nutrition education programmes should be tailored to the different needs of the diet use groups.

The present study examines the relationships between health status, medication usage and depression in a community sample of elderly francophones. The results reveal that the use of non-psychotherapeutic medication is significantly greater by subjects who are physically impaired and those who are depressed. In addition, physically impaired subjects use significantly more psychotherapeutic medication than those in good health, whereas there is no difference between depressed and non-depressed subjects. The results also show that women use more psychotherapeutic medication than men. Thus, health status and depression both account for the increased use of non-psychotherapeutic medication in the elderly. In addition, the greater use of psychotherapeutic medication by the physically impaired and the lack of difference in the use of psychotherapeutic medication between depressed and non-depressed may point to possible over prescription for the elderly.

Hospital and long-term care facility utilization, mortality and functional status over a 12-month follow-up period are described for elderly home care recipients who had been discharged from an acute care hospital. Of those eligible for receipt of services from the Program, 356 (92%) patients 65 years of age and older agreed to participate in the study at the time of discharge from an acute care hospital. Of these, 82.2 per cent survived during the subsequent 12 months, 44 per cent were readmitted to hospital, and 5 per cent were admitted to a nursing home or home for the aged. After adjusting for socio-demographic and health variables using regression analyses, the total number of home care services received was significantly associated with physical function and social function at 12 months. Similarly, the analyses revealed home care “social services” (social worker visits, meals on wheels, visiting home maker visits and volunteer visits) received were significantly associated with morale at 12 months. The clinical significance of these findings for case-management and home care program management and monitoring are discussed.

To determine whether frequent vitamin C supplement use is associated with healthier behaviours, and a history of cancer and other illnesses in UK women.

Design

The present cross-sectional analysis examines the odds of taking supplements containing vitamin C as recorded in 4 d food diaries, based on lifestyle characteristics and morbidity history self-reported by questionnaire.

Setting

A large national UK cohort study.

Subjects

A total of 12 453 women aged between 37 and 79 years.

Results

Women frequently taking supplements containing vitamin C, compared to those who did not, had healthier behaviours, including higher consumption of fruit and vegetables. Frequent high-dose vitamin C users (≥1000 mg) had a higher socio-economic status, visited alternative practitioners more often than family or private doctors, and were more likely to be ex-smokers and to drink little or no alcohol. Women who self-reported having had cancer (OR = 1·33, 95 % CI 1·00, 1·76) or specifically breast cancer (OR = 1·70, 95 % CI 1·14, 2·55), or reported a family history of cancer (OR = 1·16, 95 % CI 0·95, 1·41) or breast cancer (OR = 1·26, 95 % CI 1·01, 1·58) had increased odds of being frequent high-dose users after adjusting for sociodemographic and health behaviours. Women with personal or family histories of some cardiovascular or intestinal disorders were more likely to take supplements containing vitamin C, though not necessarily at high doses.

Conclusions

High-dose vitamin C intake by UK women was associated with healthier behaviours and a history of breast cancer, total cancer and other illnesses. Consequences of high-dose vitamin C supplement intake are not clear at the population level.